Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | ME90465 | FL |
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | ME90465 | FL |
NPI | 1154366607 |
---|---|
Provider Name | Dr. Keri Ann Baacke |
First Address | Orlando, FL 32804-5505 |
Second Address | Orlando, FL 32804-5505 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2006 |
Last Update Date | 25/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
270175800 | (05) | FL |